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Women's Health

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Inconclusive Pap Smear?


Everything does turn out to be OK for the vast majority of women who have abnormal or inconclusive Pap smears. Of the more than 2 million Pap smears that are labeled suspicious each year, only about 5-10% turn out to be cancerous or precancerous. Approximately 13,000 women in the U.S. are diagnosed with cervical cancer annually, and 4,400 die from it.

Although a negative HPV test can be considered conclusive, a positive test means little because roughly 40 million Americans have the virus. HPV is one of the most common sexually transmitted diseases in the U.S., and more than 60 types of the virus have been identified. Only a handful, however, are associated with cervical cancer.

The NCI researchers evaluated the value of HPV testing in nearly 2,200women with inconclusive Pap results identified as atypical squamous cells of undetermined significance (ASCUS) and another 848 women with low-grade squamous intraepithelial lesions (LSIL). Among women with LSIL, testing for HPV was not useful in identifying those who didn't need colposcopies. But among those with ASCUS, it was.

"We found that the test was equally sensitive for all ages, but the predictive value of the test -- the number of positive women who actually have the disease -- was much higher in older women," lead author Mark E. Sherman, MD, of NCI's Environmental Epidemiology Branch, tells WebMD.

"As people get older, their background infection level actually goes down," he says. "So when we do see the infection it may mean more. We know that most women who test positive for HPV do not have cervical cancer, but that may be especially true for younger women."

The American Medical Women's Association is the first major health organization to weigh in on the subject of HPV testing in cervical cancer screening, but it will not be the last. Long-awaited guidelines from leading medical organizations are due to be made public within the next few months.

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